Health focus: Trending away from elective deliveries’

Saturday

Nov 22, 2014 at 9:30 PM

In our fast-paced, busy lives, we typically don’t like being inconvenienced. And we like to be in control.So giving birth on nature’s schedule can be a whole lot less appealing to mothers than delivering...

Richard Salit Journal Staff Writer richsalit

In our fast-paced, busy lives, we typically don’t like being inconvenienced. And we like to be in control.

So giving birth on nature’s schedule can be a whole lot less appealing to mothers than delivering around their own schedules. Avoiding the uncomfortable final days of a long pregnancy and knowing that your doctor or midwife will be there to deliver your baby can also make deliveries by appointment enticing.

Those attractions, combined with the scheduling benefits to physicians, helped drive a trend in “elective deliveries” that research has found to be potentially harmful to babies. The studies found a surprisingly high rate of health complications in babies delivered in what, at the time, was commonly regarded as full-term.

Full-term was thought to be between 37 and 41 weeks, but the studies found that the odds of babies needing to be sent to neonatal intensive care units were 2 1/2 times greater in the 37th week and even 1 1/2 times greater in the 38th week, according to James O’Brien, director of inpatient obstetrics at Women & Infants Hospital. Those were weeks when elective deliveries might be scheduled.

The revelations helped spark a nationwide public awareness campaign, led by the March of Dimes, to curb elective deliveries in those weeks. And the reforms have taken root in Rhode Island and earned O’Brien a local award.

Led by O’Brien, Women & Infants has dropped its rate of deliveries before the 39th week to below the national benchmark of 5 percent.

“We are pretty much at zero,” he says. “We have basically eliminated elective delivery before 39 weeks.”

The hospital began putting together a program three years ago and now has in place the strictest of three types promoted nationally. The most basic one is simply educating medical staff and patients about the issue. The next level, a “soft stop,” requires some enforcement.

What Women & Infants adopted, O’Brien says, is a “hard stop” approach. Working with doctors and midwives, the hospital requires an extensive review of records and ultrasounds when elective deliveries are being scheduled — not on the day of the appointment, as in the past — to ensure that mothers are indeed into their 39th week of pregnancy.

Exceptions, of course, are made for caesarean and induced deliveries for valid medical reasons, he says. Those account for about 15 percent of elective deliveries, while most of the remainder are mothers who have previously had caesareans.

“That’s the population we are focused on, ensuring at the time of delivery that they are 39 weeks or beyond. I personally review the dating for all our scheduled caesareans,” says O’Brien. “We just want to be sure it’s the safest time for the mom and the baby.”

He also points out that the number of induced deliveries has declined over time.

To recognize O’Brien and his obstetrics team, the Hospital Association of Rhode Island recently presented them the Edward J. Quinlan Award for patient safety excellence. The award is named after the association’s longtime director, who retired in May.

The elective delivery initiative is part of the national Hospital Engagement Network, a program aimed at reducing readmissions and preventing avoidable harm at hospitals. Rhode Island is one of 33 states participating.

“We try to provide leadership” in the state, says O’Brien, noting that Women & Infants performs nearly three-quarters of the deliveries in the state and works with sister hospitals in the Care New England Health System — Kent and Memorial.

Newport Hospital, the only hospital in the Lifespan network with obstetrics, also has taken part in the initiative and has achieved zero elective deliveries for mothers at less than 39 weeks, according to Debra Venancio, manager of maternal and child health.

On Monday, Rhode Island Kids Count’s annual Celebration of Children’s Health Luncheon will highlight the 20th anniversary of RIte Care, the state’s Medicaid program for children and their families.

About 33 percent of the state’s children are covered exclusively through RIte Care, up from 26 percent in 2009. However, 12,000 children, or 5.4 percent in the state, still lack insurance. Because the state’s progress stalled, its national ranking fell to 16th in 2013, down from 10th place the prior year.

“Right now, we are at a critical juncture in terms of our commitment to the health of our most vulnerable children and families,” Elizabeth Burke Bryant, Kids Count executive director, said in a statement. “Other states are finding ways to finish the job and cover all of their kids. We need to make sure that our long-standing commitment to children’s health coverage does not erode. … Comprehensive children’s health coverage is the cornerstone of overall health and well-being.”

More than 180 community and health leaders will attend the 14th annual luncheon, including U.S. Sen. Sheldon Whitehouse, U.S. Representatives David Cicilline and James Langevin, and Lt. Gov. Elizabeth Roberts. The event, to be held at the Providence Marriott on Monday, is sold out.